Provider Demographics
NPI:1518146224
Name:ACTIVE CARE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:ACTIVE CARE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:HILTON
Authorized Official - Last Name:DEARTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:480-756-6044
Mailing Address - Street 1:2052 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-7515
Mailing Address - Country:US
Mailing Address - Phone:480-756-6044
Mailing Address - Fax:480-756-1107
Practice Address - Street 1:2052 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-7515
Practice Address - Country:US
Practice Address - Phone:480-756-6044
Practice Address - Fax:480-756-1107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4484261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center